Papers by David Feliciano, MD
Archives of Pathology & Laboratory Medicine, 2001
A 47-year-old African American woman with a past medical history of postpartum deep venous thromb... more A 47-year-old African American woman with a past medical history of postpartum deep venous thrombosis was admitted to Grady Memorial Hospital (Atlanta, Ga) with a recurrence of venous thrombosis as well as fatigue, malaise, abdominal pain, and vaginal bleeding. Her abdominal computed tomographic scan revealed a leiomyomatous uterus and a hypodense splenic mass measuring 6 ϫ 5 ϫ 5 cm (Figure 1). Subsequent workup included an upper gastrointestinal radiographic series, barium enema, and mammography, all of which were negative. Laboratory findings included a decreased hemoglobin level (9.0 mg/dL) and hematocrit (0.28). The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy with splenectomy. Two accessory spleens found at the time of exploration were removed as well. The spleen was submitted for intraoperative pathologic evaluation. It weighed 245 g and contained a well-circumscribed, centrally necrotic, tan, fleshy mass that measured 7 ϫ 6 ϫ 6 cm (Figure 2). Frozen section of the mass showed a spindle cell neoplasm with no obvious features of malig
The American Surgeon, 2008
Historically, hepatic portal venous gas (HPVG) seen on abdominal radiographic examination indicat... more Historically, hepatic portal venous gas (HPVG) seen on abdominal radiographic examination indicated serious intra-abdominal pathology requiring urgent operative intervention. The mortality attributed to HPVG is associated closely with its causative source rather than a direct effect of the presence of venous air and, therefore, the finding should be correlated with a careful clinical examination before any therapeutic endeavor. Fourteen cases of HPVG associated with blunt trauma have been reported over the past 20 years, and only half of these have resulted in surgery. We report the case of a 24-year-old woman who presented with no abdominal pathology other than HPVG after a severe motor vehicle crash. She was managed nonoperatively and made a successful recovery.
The American Surgeon, 2009
A LFRED BERNHARD NOBEL (1833-1896), a Swedish chemist, inventor of dynamite, industrialist and ph... more A LFRED BERNHARD NOBEL (1833-1896), a Swedish chemist, inventor of dynamite, industrialist and philanthropist, was the originator of the Nobel Prizes given annually since 1901. In his will signed in Paris on November 27, 1895, he directed that 31 million Swedish Kronor (5.18 million American dollars presently) be invested to fund annual prizes (by interest).
The journal of trauma and acute care surgery, 2018
Abdominal pain is the common reason patients seek treatment in emergency departments (ED), and co... more Abdominal pain is the common reason patients seek treatment in emergency departments (ED), and computed tomography (CT) is frequently used for diagnosis; however, length of stay (LOS) in the ED and risks of radiation remain a concern. The hypothesis of this study was the Alvarado score (AS) could be used to reduce CT scans and decrease ED LOS for patients with suspected acute appendicitis (AA). A retrospective review of patients who underwent CT to rule out AA from January 1, 2015, to December 31, 2015, was performed. Patient demographics, medical history, ED documentation, operative interventions, complications, and LOS were all collected. Alvarado score was calculated from the medical record. Time to CT completion was calculated from times the patient was seen by ED staff, CT order, and CT report. Four hundred ninety-two patients (68.1% female; median age, 33 years) met the inclusion criteria. Most CT scans (70%) did not have findings consistent with AA. Median AS for AA on CT sca...
American journal of surgery, Jan 23, 2016
Publishing clinical and research work for dissemination is a critical part of the academic proces... more Publishing clinical and research work for dissemination is a critical part of the academic process. Learning how to write an effective manuscript should be a goal for medical students and residents who hope to participate in publishing. While there are a number of existing texts that address how to write a manuscript, there are fewer guides that are specifically targeted towards surgery trainees. This review aims to direct and hopefully encourage surgery trainees to successfully navigate the process of converting ideas into a publication that ultimately helps understanding and improves the care of patients.
Surgery, Jul 12, 2016
A core objective of the Society of University Surgeons (SUS) is research focused: to "advanc... more A core objective of the Society of University Surgeons (SUS) is research focused: to "advance the art and science of surgery through original investigation." This study sought to determine the current impact of the SUS on academic surgical productivity. Individual faculty data for numbers of publications, citations, and National Institute of Health (NIH) funding history were collected for 4,015 surgical faculty at the top 55 NIH-funded departments of surgery using SCOPUS and the NIH Research Portfolio Online Reporting Tools. SUS membership was determined from membership registry data. Overall, 502 surgical faculty (12.5%) were SUS members with 92.7% holding positions of associate or full professor (versus 59% of nonmembers). Median publications (P) and citations (C) among SUS members were P: 112, C: 2,460 versus P: 29, C: 467 for nonmembers (P < .001). Academic productivity was considerably higher by rank for SUS members than for nonmembers: associate professors (P: 61 ...
Canadian journal of surgery. Journal canadien de chirurgie, 2008
Canadian journal of surgery. Journal canadien de chirurgie, 2009
Supine anteroposterior chest radiography is an insensitive test for posttraumatic pneumothoraces.... more Supine anteroposterior chest radiography is an insensitive test for posttraumatic pneumothoraces. Computed tomography often detects pneumothoraces that were not diagnosed on chest radiography (occult pneumothoraces). Whereas the incidence of occult pneumothoraces approximates 5% of all trauma registry patients, this value approaches 15% among injured patients undergoing computed tomography. Up to 76% of all pneumothoraces may be occult to supine chest radiography with real-time interpretation by trauma teams. Although the size and intrathoracic distribution (anterior) of overt and occult pneumothoraces are similar, significantly more patients with occult pneumothoraces undergo tube thoracostomy compared with those with overt pneumothoraces. This pattern extends both to patients receiving mechanical ventilation and those with penetrating trauma. As an early clinical predictor available during the resuscitation of a trauma patient, only subcutaneous emphysema is predictive of a concur...
Journal of Trauma Management & Outcomes, 2014
This focused summary is a multi-institutional, multinational , and multi-generational project des... more This focused summary is a multi-institutional, multinational , and multi-generational project designed to briefly summarize current academic trauma societies for both trainees and faculty alike. The co-authorship is composed of former and/or current presidents from most major trauma organizations. It has particular relevance to trainees and/or recent graduates attempting to navigate the multitude of available trauma organizations.
Canadian journal of surgery. Journal canadien de chirurgie, 2009
European Journal of Trauma and Emergency Surgery, 2009
Objective: Hemothorax is a common sequela of chest trauma. Complications after chest trauma inclu... more Objective: Hemothorax is a common sequela of chest trauma. Complications after chest trauma include retained hemothorax and empyema requiring multiple interventions. We studied the epidemiology of hemothorax and its complications at a level I trauma center. Methods: The trauma registry was reviewed from Jan 1995 to May 2005. All patients ‡ 16 years of age who were admitted with hemothorax, an AIS chest score of ‡ 3, and did not receive an immediate thoracotomy were entered in the study cohort. The patient demographics, details of the injury event, treatments, hospital length of stay (LOS), complications and outcome were analyzed. Results: The study cohort of 522 patients with a hemothorax were treated with 685 chest thoracostomy tubes. Overall, the median ISS was 18 and 62% were penetrating injuries. 109 patients (21%) had a retained hemothorax and required placement of ‡ 2 chest tubes with a median LOS of 15 days longer than patients with no retained hemothorax (p < 0.0001). The overall complication rate was 5% (26/522). Of these, 20 patients had empyema (3.8%), 8 patients required decortication, and 6 patients received streptokinase treatment. Conclusions: More than 1 out of every 5 patients undergoing intervention for trauma-induced hemothorax develops a complication. The development of retained hemothorax is associated with empyema in 15.6% of cases and a 2-week median increase in length of stay. Future research into interventions such as Video-assisted thoracoscopic surgery (VATS) on the day of admission to completely evacuate hemothorax is warranted to reduce complication rates, length of stay and cost.
European Journal of Trauma and Emergency Surgery, 2013
Archives of Surgery, 2005
Archives of Surgery, 2005
Annals of Surgery, 1999
This is a report of 50 consecutive patients with juxtapyloric perforations after smoking "crack" ... more This is a report of 50 consecutive patients with juxtapyloric perforations after smoking "crack" cocaine (cocaine base) at one urban public hospital. Summary Background Data Although the exact causal relation between smoking crack cocaine and a subsequent juxtapyloric perforation has not been defined, surgical services in urban public hospitals now treat significant numbers of male addicts with such perforations. This report describes the patient set, presentation, and surgical management and suggests a possible role for Helicobacter pylori in contributing to these perforations.
The American Journal of Surgery, 2009
BACKGROUND: Current recommendations for victims of penetrating trauma include prompt transportati... more BACKGROUND: Current recommendations for victims of penetrating trauma include prompt transportation to a trauma center. It remains unclear whether field intubation allows for improvements in mortality rate. METHODS: A retrospective review of the National Trauma Data Bank of adult victims of penetrating trauma was performed. Standard demographic data, method, and location of airway management were examined. Mortality rate was used as the primary outcome measure. RESULTS: There were 56,094 victims of penetrating trauma identified. A total of 1,925 patients required a prehospital airway. The mortality rate for patients who underwent airway management at the scene was 69.2%, compared with a rate of 35.9% for patients in whom airway management was deferred. The mortality rate for patients undergoing surgical airway management at the scene was only 23.9%. CONCLUSIONS: Victims of penetrating trauma who require any airway management have a high mortality rate. The cause of this difference awaits further prospective investigation.
World journal of emergency surgery : WJES, Jan 3, 2009
A 22-year old male presented with a transected femoral artery following a gunshot wound. He under... more A 22-year old male presented with a transected femoral artery following a gunshot wound. He underwent a successful primary repair following limited segmental resection of the injured segment. End-to-end anastomoses after resection of injured arteries include, but are not limited to, interrupted and continuous suturing with, or without "parachuting" of the graft and/or vessel. We offer a rapid and reliable repair using a conceptually and operationally simple technique. Major advantages include: 1) the operating system is always oriented towards the surgeon, 2) the posterior row of sutures is placed as both ends are readily visualized, avoiding the need for potentially obscuring traction stitches, and 3) flushing is easily performed prior to completing the anterior suture row.
Journal of Trauma and Acute Care Surgery, 2017
Background: High energy missiles can cause cardiac injury regardless of entrance site. This study... more Background: High energy missiles can cause cardiac injury regardless of entrance site. This study assesses the adequacy of the anatomic borders of the current "cardiac box" to predict cardiac injury. Methods: Retrospective autopsy review was performed to identify patients with penetrating torso gunshot wounds 2011-2013. Using a circumferential grid system around the thorax, logistic regression analysis was performed to detect differences in rates of cardiac injury from entrance/exit wounds in the "cardiac box" vs. the same for entrance/exit wounds outside the box. Analysis was repeated to identify regions to compare risk of cardiac injury between the current cardiac box and other regions of the thorax. Results: Over the study period, 263 patients (89% male, mean age = 34 years, median injuries/person = 2) sustained 735 wounds [80% gunshot wounds (GSWs], and 239 patients with 620 GSWs were identified for study. Of these, 95 (34%) injured the heart. Of the 257 GSWs
Canadian Journal of Surgery, 2014
Background: Air ambulance transport for injured patients is vitally important given increasing pa... more Background: Air ambulance transport for injured patients is vitally important given increasing patient volumes, the limited number of trauma centres and inadequate subspecialty coverage in nontrauma hospitals. Air ambulance services have been shown to improve patient outcomes compared with ground transport in select circumstances. Our primary goal was to compare injuries, interventions and outcomes in patients transported by helicopter versus nonhelicopter transport. Methods: We performed a retrospective 10-year review of 14 440 patients transported to an urban Level 1 trauma centre by helicopter or by other means. We compared injury severity, interventions and mortality between the groups. Results: Patients transported by helicopter had higher median injury severity scores (ISS), regardless of penetrating or blunt injury, and were more likely to have Glasgow Coma Scale scores less than 8, require airway control, receive blood transfusions and require admission to the intensive care unit or operating room than patients transported by other means. Helicopter transport was associated with reduced overall mortality (odds ratio 0.41, 95% confidence interval 0.33-0.39). Patients transported by other methods were more likely to die in the emergency department. The mean ISS, regardless of transport method, rose from 12.3 to 15.1 (p = 0.011) during our study period. Conclusion: Patients transported by helicopter to an urban trauma centre were more severely injured, required more interventions and had improved survival than those arriving by other means of transport. Contexte : Le transport par ambulance aérienne pour les polytraumatisés est d'une importance vitale compte tenu du volume croissant de patients, du nombre limité de centres de traumatologie et des effectifs insuffisants en médecine de spécialité dans les hôpitaux dépourvus d'unités de traumatologie. Les services de transport ambulanciers aériens ont la capacité d'améliorer les résultats chez les patients, comparativement au transport terrestre dans certaines situations. Notre objectif principal était de comparer les traumatismes, les interventions et les résultats chez les patients transportés par hélicoptère ou autrement. Méthodes : Nous avons procédé à une revue rétrospective sur 10 ans du transport de 14 440 patients vers un centre urbain de traumatologie de niveau 1 par hélicoptère ou autrement. Nous avons comparé la gravité des blessures, les interventions et la mortali té entre les groupes. Résultats : Les patients transportés par hélicoptère présentaient des indices médians de gravité des blessures plus élevés, indépendamment de la nature ouverte ou fermée des blessures, et ils étaient plus susceptibles de présenter un score inférieur à 8 sur l'échelle de Glasgow, de nécessiter une intubation, de recevoir des transfusions sanguines et d'être admis aux soins intensifs ou au bloc opératoire, comparativement aux patients transportés autrement. Le transport par hélicoptère a été associé à une mortalité globale moins élevée (rapport des cotes 0,41; intervalle de confiance de 95 % 0,33-0,39). Les patients transportés autrement étaient plus susceptibles de mourir à l'urgence. Le score moyen de gravité des blessures, indépendamment du moyen de transport, est passé de 12,3 à 15,1 (p = 0,011) durant la période de l'étude. Conclusion : Les patients transportés par hélicoptère vers un centre de traumatologie urbain étaient plus grièvement blessés, nécessitaient plus d'interventions et leur survie a été meilleure que celle des patients transportés autrement.
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Papers by David Feliciano, MD